What is the most effective treatment for gambling?

The most frequently studied treatment type for gambling disorder is Cognitive Behavioral Therapy (CBT). This type of treatment attempts to change the thoughts and behaviors that are fundamental to maintaining a pattern of behavior (e.g., gambling disorder).

mass.gov - Treatment recommendations for gambling disorders - Mass.gov

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Relapse Prevention

Relapse prevention and recovery training are treatment components that clinicians design and use to increase a person’s ability to identify and cope with high-risk situations that can precipitate relapse. Gambling risk situations might include environmental settings (e.g., casinos, lottery outlets), intrapersonal discomfort (e.g., anger, depression, boredom, stress), and interpersonal difficulties (e.g., finances, work and family). The Inventory of Gambling Situations is one tool that can help individuals identify circumstances that increase their risk of gambling. Relapse prevention’s goal is to help individuals develop coping methods to deal effectively with those specific high-risk situations without relying on unhealthy and maladaptive gambling behavior. A number of studies have incorporated relapse prevention as a component of their trials. These studies suggest that relapse prevention in combination with other cognitive therapy (e.g., cognitive correction) is associated with clinically favorable outcomes, like reducing time and money spent gambling. Cognitive correction is a technique that seeks to correct individuals’ misconceptions of basic gambling-related concepts (e.g., randomness). Other studies have determined that both individual and group relapse prevention treatment for gambling disorder are superior to a no-treatment control group. Taken together, these findings suggest that relapse prevention is a promising and developing treatment approach for gambling.

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Brief treatment can take a number of different forms, including limited motivational enhancement therapy, as we mentioned previously. Brief treatment does not necessarily need to include motivational enhancement, however. These interventions might include a 10 minute conversation or a few counseling sessions of cognitive behavioral therapy, for example, but not protracted clinical involvement. A brief treatment might include a gambling disorder screen, information about harmful consequences of excessive gambling, or simply advice for reducing gambling-related harm. Studies of brief advice suggest that it is associated with clinically significant changes in gambling behavior. Documented benefits of brief advice are apparent as early as six weeks following an intervention and as long as nine months later. Additional studies of brief advice from other sources will help confirm brief advice as an important treatment approach for gambling.

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Medications

There is no specific FDA-approved pharmacotherapy for the treatment of gambling disorder. Researchers are testing a variety of drugs, and some show promise. To date, there are randomized clinical trials that show favorable outcomes for escitalopram, lithium, nalmefene, valproate, topiramate, paroxetine, and naltrexone. However, at this time, no single drug has sufficient support for us to classify it as a treatment with “High Quality Empirical Evidence.” Some of these medication trials are quite preliminary. For example, some randomized clinical trials meet the technical definition of a trial, but include as few as four individuals. Escitalopram is a medication typically used to treat mood disorders. It is a selective serotonin reuptake inhibitor (SSRI). Lithium is a drug frequently used to treat bipolar disorder and major depressive disorder. It is considered a mood stabilizer. Nalmefene is an opioid antagonist. Most often providers use it to treat alcohol-related disorder. Valproate is an anticonvulsant that typically is used to treat seizures, bipolar disorder, and migraines. Topiramate is a nerve pain medication and anticonvulsant that acts on dopamine pathways and typically is used to treat seizures and migraines. Paroxetine is an SSRI; this medication often is used to treat mood disorders. Finally, naltrexone is an opioid antagonist usually used to treat alcohol and opioid use disorders. Additional research is necessary to study the effects of all these drugs before they are used routinely in a clinical setting for gambling-related problems; however, these early studies are promising, and suggest that some drugs might eventually be useful to treat gambling-related problems.

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Cognitive Therapies

Cognitive therapies seek to help individuals learn to rethink certain matters including those that are intrapersonal and interpersonal. For gambling, this might mean developing a better understanding of randomness, or identifying and correcting erroneous beliefs and perceptions, like the illusion of control often associated with gambling and gambling disorder. Two clinical trials from the same source focusing on cognitive correction with relapse prevention suggested favorable clinical outcomes. Other studies with less rigorous designs (i.e., non-randomized or pre-post comparisons) also suggest that cognitive therapies are worthwhile approaches to the treatment of gambling. We are classifying this popular approach to treatment as “developing” for gambling because we need more studies that focus upon cognitive therapy in isolation from multiple sources. However, this treatment approach is quite promising for gambling disorder.

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Behavioral Therapies

Behavioral therapy seeks to undo learned associations between a particular stimulus, such as gambling triggers, and an unwanted response, such as feeling an urge to gamble when in the presence of a trigger. One example, exposure therapy seeks to help people eliminate the experience of gambling-related urges in response to actual gambling experiences. Similarly, imaginal desensitization intentionally provokes gambling-related urges using imagery and immediately provides assistance with cognitive restructuring and the presence of incompatible responses (e.g., relaxation). One way of doing this is through the use of audiotaped recordings of gambling scenarios. Despite the popularity of this treatment type, most studies of behavioral therapy for gambling disorder rely upon weak experimental designs that make drawing causal attributions about treatment efficacy difficult. One trial, however, shows that, in combination with relapse prevention, imaginal desensitization can reduce key gambling-related urges effectively.

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mass.gov - Treatment recommendations for gambling disorders - Mass.gov

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